
How sudden cardiac arrest can be different for athletes — based on their sex
When varsity rower Ruth McDonald competes, she's thinking about pushing herself hard and winning the race. The potential of suffering a medical emergency — while always possible — is the last thing on her mind.
"Every sport, you have to be comfortable with pain and comfortable with getting uncomfortable," she said. "So something like injury or having cardiac arrest is not something you have on your mind, because you're so focused on working so hard and achieving the best results possible."
Sudden cardiac arrests in female athletes are a rising concern for sports medicine experts because doctors say they're realizing how little they know about the heart health of female athletes, and their risk level for the condition.
While rare, sudden cardiac arrests are a leading cause of death for young athletes. According to a Canadian study published in March, men are over 10 times more likely to experience a sports-related cardiac arrest than women.
But women, when their hearts suddenly stop, are less likely to survive, according to several studies.
Reasons unclear
Dr. Paul Dorian, who co-authored the Canadian study, says there aren't clear explanations for the disparity between male and female athletes.
But he pointed to one problem: Cardiac arrests in male athletes are more likely caused by heart rhythm disturbances, like an arrhythmia, due to a hardening of the arteries.
"Think of it as a heart attack in waiting. So those are plumbing problems, which then cause an electric problem," said Dorian, a cardiologist at Toronto's St. Michael's Hospital.
In female athletes, by contrast, cardiac arrests are often from a different cause, says Dorian: They're more likely due to heart diseases from heritable causes, or which developed from viruses.
Another factor, Dorian says, is that women may not always realize when they are about to have a cardiac arrest. Whereas men are more likely to have the classic symptoms of an emergency, like chest pain or chest tightness, women are more likely to experience symptoms like fatigue, shortness of breath and exhaustion.
Another key factor that can affect whether someone survives or dies of a sudden cardiac arrest: how quickly bystanders react, says Dorian.
Bystanders tend to step in less frequently to resuscitate a woman, whether through CPR or putting the woman on an automated external defibrillator, also known as an AED.
Researchers don't have a lot of data on why. It may be that some bystanders don't recognize the symptoms in women, or they feel reluctant to perform chest compressions, or to remove a woman's shirt and place the defibrillator pads on her chest.
Physiological differences
There are also differences between male hearts and female hearts — in size, electrical system and blood vessels, says Dr. Paula Harvey, a heart specialist and the head of medicine at Women's College Hospital in Toronto.
"We are behind the game, so to speak, when it comes to understanding the biology of women's hearts with respect to the impact of different types of sports and different types of stressors," she said.
Some of the key questions she wants answers to: the best ways to screen female athletes for structural heart disease and electrical heart problems that could put them at risk — and the best ways to respond to somebody who has a cardiovascular complication or emergency while on the playing field.
Harvey is trying to fill in some of those blanks, researching how age and hormonal changes, like menopause, can affect women's cardiac health.
Specifically, Harvey is studying female athletes who have stopped having periods and showing symptoms that resemble menopause, because they're not eating enough calories to balance out all their training — and how the energy imbalance impacts heart health.
That can be hard on the cardiovascular system, suggests Harvey's research, which she recently presented at the Female Athlete Conference in Boston. She thinks not enough athletes are aware of the problem, which she says can easily be corrected — and the symptoms reversed — by eating more.
"Even just a granola bar to increase that number of calories," she said.
Dr. Steven Joseph, chief medical officer of Rowing Canada, also thinks there is much more to be learned about sex differences and risk factors for sudden cardiac arrest.
"We're just starting to realize there are significant physiological differences," he said. "A lot of the old studies were based on male athletes and they're not transferable."
Joseph is hoping there will be more research that could inform athletes and coaches on how to train safely — and manage risk factors.
Because — Harvey, Joseph and Dorian all agree — physical activity has so many benefits for overall health, not just cardiac health.
They just want everyone to be able to do it safely.
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CTV News
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Recap: Here's what court heard about each of the 5 accused in the hockey players' sex assault trail
The judge in the world junior sexual assault trial is expected to hand down her verdict on Thursday. CTV London's Nick Paparella recaps the trial. The judge in the world junior sexual assault trial is expected to hand down her verdict on Thursday. CTV London's Nick Paparella recaps the trial. An Ontario judge is set to deliver her ruling Thursday in the case of five hockey players accused of sexually assaulting a woman in a London, Ont., hotel room seven years ago. Michael McLeod, Carter Hart, Alex Formenton, Dillon Dube and Callan Foote have all pleaded not guilty to sexual assault in the June 2018 encounter, and McLeod has also pleaded not guilty to a separate charge of being a party to the offence of sexual assault. Prosecutors argue the woman did not voluntarily consent to any of the sexual acts that took place after several team members arrived in the room, nor did the accused players take reasonable steps to confirm that she did. The defence argues the woman initiated and actively participated in the sexual activity, and at times taunted the players to do things with her. Here's a recap of the Crown's and defence lawyers' arguments about each player, as well as some of the key evidence. Since the burden of proof is on the Crown, much of the evidence discussed was presented by the prosecutors. People accused of crimes are not required to testify or present evidence, and police statements can only be used as evidence for the person who made them. CAUTION: The following paragraphs contain graphic content some readers may find disturbing. Michael McLeod Prosecutors allege McLeod was the one who 'orchestrated this whole sordid night,' offering sexual activities with the complainant – with whom he'd just had sex in his hotel room – to his entire team without her knowledge or consent. They argue he should be found guilty of being a party to the offence of sexual assault because he took steps to encourage others to sexually assault the complainant. McLeod texted the team group chat shortly after 2 a.m., asking if anyone wanted to have a threesome, court heard, and offered oral sex from her to two teammates directly, one by text and the other in person. He also went out into the hallway to invite others into the room, court heard. His actions were meant to give the impression that the woman was interested in taking part in sexual activity, the Crown argued. McLeod also took two short videos of the complainant that he hoped would shield the group from criminal liability, the Crown said. In one, the woman says she's 'OK with this,' and in the other, that it was 'all consensual.' In a 2018 interview with police, McLeod said he took the first video because he was 'kind of worried something like this might happen,' meaning the investigation. He did not tell the investigator about his text to the team group chat. The videos are not evidence that the woman actually consented, prosecutors argued, noting that consent must be given for each act at the time it occurs. The Crown also alleges McLeod sexually assaulted the complainant when he twice obtained oral sex from her after the others arrived, and when they had sex in the shower at the end of the night. The woman testified that three men put their penises in her face while she was on a sheet on the floor. The Crown alleges McLeod was one of these men, though the woman could not identify them. Some people shouted commands as the woman performed oral sex, and she felt someone spit on her back, then slaps on her buttocks, she told the court. She performed oral sex on McLeod later while he lay on the bed, and again she felt slaps on her buttocks, hard enough to hurt, she said. They had sex in the shower later, she said, describing it as one last thing she felt she needed to do before she was able to leave. The Crown argues there is no evidence of any conversation between McLeod and the complainant about those sexual acts, or evidence that he took any steps to verify that she was voluntarily consenting. Rather, the Crown argues, he was relying on legally incorrect beliefs about what consent is and how it can be communicated. In his interview with police, McLeod said he left the room briefly to pick up food after some others arrived, and when he returned, the woman was giving oral sex to Hart. More men arrived, he said, and at one point the woman started asking them to have sex with her. She was upset when no one would take her up on it, and later offered oral sex, he said in the interview, which was played in court. McLeod, who did not take the stand at trial, only described receiving oral sex once in his interview with police, in close succession with Hart and maybe Dube. The woman came into the shower with him later and they had sex, he said. He told the investigator he checked in with her throughout the night to make sure she was OK with what was happening. Defence lawyers for McLeod argue the woman presented an 'entirely unbelievable and unreliable' version of what transpired that night, including that she engaged in sexual acts because she was afraid. The woman knew McLeod was inviting others, and he was communicating with some of the players he was trying to recruit in her presence, David Humphrey argued. She stayed in the room after her initial encounter with McLeod because she was waiting for the men to arrive, he said. The defence lawyer argued the videos his client took of the woman show she was consenting and not scared, even though they were taken after the fact. 'The evidence overwhelmingly establishes that (the woman) was communicating consent, asking players for sex, offering oral sex. And it would have been plain to Mr. McLeod … that she was consenting,' Humphrey said in his closing submissions. Carter Hart Hart arrived in the room expecting sexual acts from the complainant and didn't take any steps to confirm that she was actually consenting before obtaining oral sex from her, the Crown alleges. When McLeod texted the team group chat about a 'three-way,' Hart replied that he was 'in,' court heard. The player, who was 19 at the time, also testified McLeod told him on the phone he had a girl in his room who 'wanted to have sex with some of the boys,' meaning his teammates. Hart, who was the only player to take the stand in his own defence, told the court that he was interested but wanted to assess the situation in the room and whether the woman consented before committing to the sexual encounter. During cross-examination, prosecutors asked Hart whether he did any of that assessment when he got to the hotel, but the player said he couldn't remember. Hart's first memory of the complainant is seeing her masturbating on the floor, he said. The woman then said something along the lines of, 'can somebody come f— me?' he said. Hart said he didn't want to have intercourse so he asked the woman for a 'blowie,' meaning oral sex. He testified that she said 'yeah' or 'sure' and helped him pull down his pants. The oral sex lasted about 30 to 60 seconds because Hart couldn't become fully erect and felt weird about the situation, he said. The Crown alleges Hart also received oral sex on a second occasion, in quick succession with McLeod and Dube, pointing to the complainant's account as well as some of the testimony of two other teammates, Brett Howden and Tyler Steenbergen. Hart agreed under cross-examination that it was possible but said he couldn't remember. Prosecutors argue Hart acted on the belief that because the woman had offered sex, it meant she was consenting to any sexual act with any man. '(The woman) never invited a blow job or oral sex, even on Mr. Hart's account,' Donkers argued in closing submissions. Hart was the only witness to testify that he asked for a 'blowie,' and his evidence should be disregarded as not credible or reliable, the Crown said in its written submissions. Even if it was true, the Crown argued, that would not be enough to conclude that he had an honest but mistaken belief the woman was consenting because the 'highly unusual and oppressive circumstances' required him to take more steps to confirm it. Defence lawyers representing Hart argued the woman gave 'unequivocal communicated consent' to oral sex with their client. Megan Savard urged the judge to accept her client's evidence that he made an 'explicit and specific request' for oral sex after the complainant offered vaginal sex, and that the complainant agreed verbally and through her actions. Savard argued there is also no evidence of the classic factors capable of vitiating or removing consent, such as physical coercion, blocking the door or threats, just the complainant's vague and 'unfounded feeling' that some of those things might happen. Alex Formenton The Crown argues Formenton did not take any steps to confirm whether the woman consented before having sex with her in the hotel room's bathroom. Formenton, who was 18 at the time, did not testify at trial but he told police in 2018 that he 'volunteered' to have sex with the woman after she asked the group if anyone would 'do anything' with her. Formenton told police he said he didn't want to have sex in front of the group, then followed the woman when she walked into the bathroom. He put on a condom, they had sex, then he took off the condom and finished with oral sex, he said. He did not mention any conversation between them. In her testimony, the woman described someone following her when she got up to go to the bathroom, and said she resigned herself that sex was going to happen. She felt she did not have control over the situation, she said, and did not recall any conversation with Formenton. Howden testified that Formenton made a comment along the lines of 'should I be doing this?' to a few teammates as he and the woman walked to the bathroom. He couldn't remember if anyone answered directly but said people 'just left it up to him.' Prosecutors argue that even if the woman did ask whether anyone would have sex with her, it does not mean that she made a voluntary choice to have sex with Formenton in the bathroom. 'He did not say that (the woman) suggested that they go to the bathroom to have sex. He did not even say he suggested they go to the bathroom to have sex and she said 'OK,'' the Crown said in its written submissions. Her walking to the bathroom is ambiguous conduct and not indicative of consent, the Crown argued. The judge, however, said during the Crown's closing submissions that it was all part of the sequence of events that she must consider. Ontario Superior Court Justice Maria Carroccia said that if she finds the woman asked the group if anyone would have sex with her, then Formenton stood up and said he would do it but not in front of others, and the woman then walked to the bathroom with Formenton following behind, it's 'not so ambiguous, in those circumstances.' Formenton's lawyer, Daniel Brown, argued the evidence overwhelmingly establishes that the woman consented to sex with his client. 'They both agreed. It's not complicated,' he said in his closing submissions. Dillon Dube Prosecutors allege the woman did not voluntarily consent to perform oral sex on Dube, nor could she consent to being slapped on the buttocks because she didn't know it was going to happen. Dube did not testify at trial but told police in 2018 that he didn't know what was going on when he walked into the room and saw a naked woman lying on a sheet on the floor. He had a golf club in his hand because they were taking part in a tournament in the morning, and the woman said something like, 'are you going to play golf or f— me?' he said. The woman announced she was leaving because no one would have sex with her, but stayed after Hart said he would do something, Dube said in the interview. She performed oral sex on Hart, and at some point, Dube stood up and thought, 'I might as well,' he said. He pulled down his pants and received oral sex for about 10 seconds before realizing it was 'a bad idea' and stumbling back, he said. He left soon after with Foote and another teammate, he said. Dube did not tell the investigator he touched the complainant's butt, nor was he asked about it. His lawyer said Dube may have forgotten to mention it and may not have realized its significance in the context of the night. Steenbergen saw Dube slap the woman's butt after Hart received oral sex but before McLeod did, he told the court. 'It wasn't hard, but it didn't seem soft either,' he said. Prosecutors are asking the judge to find that Dube also slapped the woman's butt a second time while she performed oral sex on McLeod on the bed, based in part on Howden's evidence that he left soon after hearing it. Later, after Hockey Canada started looking into the allegations, Dube called and asked Steenbergen not to tell investigators what he had done, he testified. Howden also testified that Dube called and asked him not to mention it to investigators. The woman testified she did not consent to being slapped and was not challenged on it, the Crown argued. The only suggestion put to her on this issue during cross-examination was that the slap occurred after the golf comment to Dube, which she denied making, the Crown said. There is 'zero evidence' from any witness that Dube took steps to verify that the woman consented to being slapped on the butt, prosecutors argued. Nor could he have had 'any legitimate belief' that she had communicated consent for it, they said. The woman did not consent to the oral sex either, and the transition between Hart, Dube and McLeod occurred quickly with no conversation, the Crown argued. The woman 'barely even had occasion to see Mr. Dube's face before he put his penis in her mouth,' it argued. 'She was not consenting to oral sex with anyone, let alone Mr. Dube specifically, and identity of the partner is a central feature of consent.' Dube's lawyer argues the oral sex her client received was consensual, and his interview with police establishes there was some communication between him and the complainant about the sexual activity. The complainant has not identified who she alleges slapped her, and Steenbergen – the only person to remember seeing it – agreed under cross-examination that it was playful and not abusive, Lisa Carnelos said. Dube admits he 'placed his hand on (the woman's) buttocks' in the manner described by Steenbergen, she said. It amounts to 'nothing but a very minor playful act consistent with foreplay' between two people who were already engaged sexually, she argued. Callan Foote Prosecutors allege Foote did the splits over the complainant at the urging of his teammates and grazed his genitals on her face without her consent. The woman testified that after she performed oral sex on three men, a fourth man who wasn't wearing pants did the splits right over her face and put his penis on it. She didn't see his face, she told the court. She 'could not consent to something she did not expect was going to happen by someone whose face she didn't even see,' the Crown argued in its written submissions. The only evidence that the woman agreed to this act came from Hart, whose testimony on the issue was 'contrived' and 'unbelievable,' the prosecution argued. At one point in the night, Hart testified, some of the men started egging on Foote to do the splits. Hart said he saw the other player do the splits over the woman as she lay on the ground, without touching her body. Foote was wearing shorts and a T-shirt at the time, Hart said. The players thought it was funny and Hart said he saw the woman laughing as well. Under cross-examination from Foote's lawyer, he agreed he didn't view the incident as sexual and that Foote pushed on the bed to hoist himself back up. However, in cross-examination by the Crown, he acknowledged that he agreed Foote used the bed to get up because it was suggested by the other player's lawyer, and because 'it makes sense.' Hart agreed that everything involving the complainant in that room was sexual, and in that context, it does not make sense that the group would find it entertaining to see Foote do partial splits while clothed, particularly since they had seen him do the splits earlier that night at the bar, the Crown argued. Hart's evidence that the woman consented to the splits was based on the fact that she was laughing, but even if the woman did laugh, that does not indicate consent, the Crown argued. Even if the judge finds the splits happened as Hart described, prosecutors argue Foote should still be found guilty of sexual assault because the complainant was naked and a reasonable observer would see the circumstances in the room as sexual. Steenbergen and Howden said Foote also called them a week later, asking that they not mention his actions to Hockey Canada investigators. Foote's defence lawyer, Julianna Greenspan, argued her client didn't touch the complainant at all. The Crown failed to prove the alleged interaction 'occurred in a sexual context,' and Hart's evidence should leave the judge with a reasonable doubt regarding the charge, the lawyer argued. Whatever took place was a 'non-threatening' and 'momentary interaction in jest,' and it happened 'in full context of smiles and laughs,' she argued, noting Foote was known for doing the splits as a 'party trick.' There is no evidence that Foote took off his pants or that anyone asked him to do so, Greenspan added. In cross-examination, Greenspan suggested to Steenbergen that he was mistaken about Foote calling him and had possibly gotten confused because of the call he'd received from Dube. Steenbergen said it was possible but that he was 'pretty sure' Foote had called him as well. Howden rejected Greenspan's suggestion that the call with Foote never happened.

Globe and Mail
an hour ago
- Globe and Mail
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Doctors turn to social media to help patients where they're at: online in a sea of misinformation This push for awareness is taking place at a time when physicians say misinformation about sunscreen is spreading online, including debunked theories positing that the products are toxic. Some posts on TikTok and Instagram claim that certain sunscreen ingredients, specifically oxybenzone and retinyl palmitate, are linked to cancer. Melanoma Canada says this is not supported by evidence. The growth of online medical misinformation is considered a major public health problem because it undermines scientific research and contributes to negative health outcomes. In the case of sunscreen, dermatologists warn about dangerous and even fatal consequences linked to people turning away from its use. They say sunscreen offers critical protection from ultraviolet, or UV, exposure. Ms. Johnston is concerned about what she's seeing play out on social media about sunscreen. This is coupled, she said, with how the platforms generate social pressures to look a certain way. 'Skin cancer, the risk of melanoma – this is serious stuff that is just not worth sitting in the sun or in a tanning bed for,' said Ms. Johnston, who is a 38-year-old content creator and model based in Owen Sound, Ont. 'You're naturally beautiful the way you are.' The Canadian Cancer Society estimated that last year, 11,300 Canadians would be diagnosed with melanoma and 1,300 others would die because of it. Of those diagnosed, the society projected 6,500 would be men, and 4,800 would be women. The World Health Organization says 85 per cent of melanomas that present in patients over the age of 30 are attributed to UV exposure. It also says tanning beds are a public health issue that account for about half a million new cancer diagnoses every year in the U.S., Europe and Australia. Falyn Katz, the CEO of Melanoma Canada, said that the cancer can affect anyone, regardless of age, sex or race. Sunscreen and sun safety is important for everyone, she added. 'Why would we not take the opportunity to prevent a potentially deadly cancer?' she said. Ms. Katz warns online misinformation about sunscreen is both worrying and dangerous. Some influencers, she said, are trying to teach people how to make their own sunscreen, without any of the medical background and knowledge required to do so. She encouraged seeking information about sun protection from reputable sources. For instance, all sunscreens available for sale on shelves, including at pharmacies, must be evaluated and approved by Health Canada. The Canadian Medical Association and other health organizations have also highlighted their concerns about the uptick in medical misinformation being widely shared on social media platforms. Timothy Caulfield, who is the research director at the Health Law Institute, and a professor in the faculty of law and school of public health at the University of Alberta, studies this space. He said what is playing out is nothing short of an 'anti-sunscreen movement.' This misinformation, he added, is creating real harm. Prof. Caulfield pointed to the sway of online influencers, including American podcaster Joe Rogan, as a big factor. Mr. Rogan's show has explored questions on whether sunscreen can harm the brain. Inside the testosterone-fuelled, regimented and expensive world of longevity influencers Meanwhile, there is robust evidence that sunscreen is effective and that most melanomas are caused by exposure to the sun, Prof. Caulfield said. At the same time, data shows younger people are less inclined to use sunscreen, which he sees as a direct result of the misinformation about it, as well as about the sun. In May, a study led by McGill University found Canadians are spending more time in the sun, but using less sun protection. It also found young adults were much more likely to get sunburned and use tanning beds than older adults. For Ms. Johnston, cancer has upended her pursuit of a golden glow. While she still seeks a bronzed look, it comes from self-tanner now, instead. 'Unsafe UV exposure, it catches up with you,' she said. 1. Look for apparel with UV protection: This can include clothing such as shorts, shirts, bathing suits and hats, from a variety of different brands. 2. Cover up as much skin as possible; consider long sleeves and a broad-brimmed hat. 3. Plan to do activities such as outdoor exercise or yardwork outside of peak UV hours, which are between 11 a.m. and 3 p.m. 4. Try to sit in the shade if you are outside. 5. Don't forget sunscreen. SPF 50 or above is recommended. Apply the product 20 minutes before swimming and reapply it every two hours or more.